抗生素的选择（英文）antibiotics

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1、ANTIBIOTICSTheselectionofantibiotictherapyforaninfectionrequiresaknowledgeof:1Theinfectingorganism,includingthepathogenmostlikelytobepresentingivenclinicalorgeographicalcircumstances2Thelocalpatternsofantimicrobialresistanceincommonpathogens3Anunderstandingofthepharmacokineti

2、csoftheantimicrobialsselected4Thephysiologyofthepatient,metabolicupset,renalorhepaticdysfunction,ageandavailableroutesofadministration.Theclinicalhistoryshoulddeterminethesystemsofthebodymostlikelytobeinvolvedindisease.Figure6.3(p.133)showscommonpathogensfoundindifferentsyste

3、ms.TheSelectionofAntibioticENDOGENOUSINFECTIONS-RESERVOIRSOFINFECTIONSINADULTSThehumanbodyisincontactwithmanypotentiallyinfectiousagents:bacteria,viruses,fungiorprotozoa.Mostareharmlesscoloniserscausingnoclinicalupsetbutforminganaturalreservoirofpotentialinfectioninthehumanho

4、stCommonInfectingOrganisms.SelectionofAntibioticsIdentificationofInfectingorganismEmpiricaltreatmentPriortoIdentificationofOrganism1.TheAcutelyIllpatient2.SelectingaDrugC.DeterminingtheAntimicrobialSusceptibilityoftheOrganismBacteriostaticvsBacteriocidalMICMBCD.EffectofSiteof

5、InfectiononTherapy:BloodBrainBarrierLipidsolubilityofdrugMolwtProteinBindingE.PatientFactorsImmunesystemRenaldysfunctionHepaticdysfunctionPoorperfusionAgePregnancyLactationF.DrugSafetyG.CostoftherapyRouteofAdministrationDeterminationofRationalDosing1Concentrationdependentkill

6、ing2.PostantibioticeffectSITESOFMICROBIALACTIONChemotherapeuticSpectraNarrowExtendedBroadCombinationofAntimicrobialsAdvantagesDisadvantagesDRUGRESISTENCE1.GeneticalterationSpontaneousmutationDNAtransferofdrugresistence2.AlteredexpressionofproteinsindrugresistantorganismsModif

7、icationoftargetsitesDecreasedaccumulationEnzymeinactivationPROPHYLACTICANTIBIOTICSRheumaticheartdiseaseDentalworkinptswithvalves,prosthesisTBSurgeryPregnantmother-zidovudineCOMPLICATIONSOPFANTIBIOTICTHERAPYHypersensitivityDirecttoxicitySuperinfectionsInhibitorsofCellWallSynth

8、esisPENICILLINPENICILLINGExtendedPenicillinsORAL-AmoxycillinIV-Ampic